In the practice of abdominal surgery, which requires the examination and manipulation of intraperitoneal and extraperitoneal organs and tissues, surgeons most often employ a long established technique of opening the abdominal wall with an incision large enough to accommodate instruments required, as well as the surgeon's hands, and to allow procedures such as anastomosis or removal of diseased organs or portions thereof. The advantages of this technique include a large degree of freedom of motion for successfully completing the procedure, sufficient space for mechanical leverage which may be necessary, and above all, tactile feedback response to the surgeon when using his hands to feel the texture, temperature, and physical response of the tissues. The disadvantages of this traditional technique, however, include long healing and recuperative time with considerable post-operative pain, and adhesion formation which can cause pain and bowel obstruction. Additionally, the traditional technique may increase the complexity of later surgery, as well as increase the possibility of post-operative morbidity and unsightly scars remaining after the procedure is completed.
In order to overcome the disadvantages of the traditional abdominal surgery method using a large incision, laparoscopic techniques have been developed which use several smaller puncture openings in the abdominal wall. These openings are used to inflate the abdominal cavity with a gas to elevate the abdominal wall away from the organs, and to allow room for the manipulation of the organs. The openings also provide means to introduce light generating and optical viewing instruments to observe the abdominal cavity, and to manipulate the organs in order to accomplish the desired results. This laparoscopic technique is becoming widely accepted because of its many advantages. These advantages include reduced adhesions, shorter recovery time, and less post-operative pain. There are also some disadvantages. For example, there are limitations on freedom to manipulate organs, and on the surgeon's viewing ability which, although magnified with the aid of a laparoscope, lacks depth perception. Most importantly, there is a lack of tactile feedback of the tissue through the surgeon's hands. Also, when a tissue specimen must be removed, a larger opening must be made in the abdominal wall near the end of the procedure, causing loss of gas pressure, collapse of the abdominal wall, and loss of interior working and viewing space.
The laparoscopic technique uses smaller puncture openings in the abdominal wall as described. These openings are usually made with a puncture device called a trocar. The trocar point and attached shaft are usually contained in a hollow circular tube which remains in the abdominal wall after puncture and through which other instrument shafts are passed to be used in the operating procedure. A sealing feature must be included in the trocar cannula body in order to maintain the gas pressure as described above. Various sizes and shapes of instruments are used in these procedures and sealing between the instruments and the trocar body must be achieved. Also, internal sealing is required within the instrument body passing through the cannula to avoid gas leakage. The importance of these sealing requirements is indicated by their inclusion in endoscopic instrument patents. For example, U.S. Pat. Nos. 5,104,383 and 5,197,955, describe sealing mechanisms between trocars and instruments passed through them. Also, the endoscopic instruments themselves contain internal sealing means to reduce the loss of gas pressure in the abdominal cavity. U.S. Pat. Nos. 5,100,420 and 5,171,249, describe internal sealing means in endoscopic instruments.
The laparoscopic assisted procedure combines the advantages of the traditional and the laparoscopic techniques for abdominal surgery. In this procedure, the normal laparoscopic small puncture openings are made with the exception that one opening is made large enough to allow a surgeon's hand to pass through the abdominal wall in order to remove tissue or deliver a mobile organ for transplant surgery. This procedure is now called handoscopy.
When this larger opening is made, a sealing device designed and sized to both fit within the incision and allows a surgeon to pass through his hand into the abdominal space with minimal loss of gas pressure.
Several surgical devices are described in patents such as Brinkerhoff—U.S. Pat. No. 5,366,478, Shimomura—U.S. Pat. No. 6,077,288, and MacLeod—U.S. Pat. No. 5,741,298. With all of these devises, the surgeon must use two hands to insert his one hand into the patient while at the same time potentially losing all of the insufflation gas from within the abdomen.
Accordingly, one object of the present invention is to allow the advantages of the laparoscopic method of maintaining gas pressure in the abdominal cavity, and of requiring relatively small incisions for quicker recovery than the traditional method, yet it allows the surgeon the important feature of tactile feedback to determine directly the information needed to successfully conclude the procedure as well as allow removal of the specimen.
In U.S. Pat. Appln. Publ. No. 2005/0020884, versions of transverse, overlapping partial seals are disclosed that address the need to a degree for a seal accessible with one hand without significant loss of insufflation pressure, but additional improvements are desirable.